Provider Demographics
NPI:1407316136
Name:DOROUDCHI, MOHAMMAD-ALI
Entity type:Individual
Prefix:
First Name:MOHAMMAD-ALI
Middle Name:
Last Name:DOROUDCHI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE STE 710
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1218
Mailing Address - Country:US
Mailing Address - Phone:858-260-2977
Mailing Address - Fax:
Practice Address - Street 1:9850 GENESEE AVE STE 710
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1218
Practice Address - Country:US
Practice Address - Phone:858-260-2977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA177620207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology